The association between maternal interaction and infant cortisol stress reactivity among preterm and full term infants at 4 months adjusted age

The purpose of this study was to assess the association between maternal interactive behavior and infant cortisol stress reactivity in response to the Still Face paradigm (SF) in a cohort of four-month old infants (adjusted age) born preterm (<32 weeks gestation, N = 22) compared with infants born full term (>37 weeks gestation, N = 28). Infant cortisol reactivity was calculated as area under the curve (AUC) from baseline to the third cortisol sample (30 min post-SF) using the trapezoidal rule, while the percent of time mothers spent using a contingent interaction style was measured (0–100%) during episodes 1 (Play; baseline), 3 (Reunion#1), and 5 (Reunion#2) while mother-infant dyads participated in the SF paradigm. We hypothesized that because infants born preterm are at increased risk for dysregulation, they would show, compared to full-term infants, a blunted stress response, involving under-responsiveness. We found blunted cortisol stress reactivity among the preterm infants. We also found that mothers of preterm infants demonstrated less contingent maternal interaction during Renion#1 of the SF; and that contingent maternal interaction at Reunion#2 of the SF was protective against cortisol stress reactivity in response to the SF. However, we did not find that the influence of maternal interaction on cortisol reactivity was moderated by gestational age group (full term vs preterm): the association between contingent maternal interaction and stress reactivity was similar for both gestational groups across episodes. In order to improve self-regulation and longer term social and cognitive developmental outcomes in medically at-risk infants, future research is warranted to determine how these findings relate to infants’ stress reactions in naturalistic settings, and the directionality and temporal relationship between cortisol stress responses and maternal interactive behavior.     

Infant's psychophysiological profile and temperament at 3 and 12 months

This study is intended to analyze (1) differences in infant temperament at 3 and 12 months according to infants’ psychophysiological profiles: “withdrawn” “extroverted”, and “underaroused” and (2) changes in infant temperament from 3 to 12 months, namely according to the infant psychophysiological profile and the quality of mother-infant interaction. Ninety-four 8-week-old infants were assessed using the Neonatal Behavioral Assessment Scale (NBAS, Brazelton & Nugent, 1995) and the Alarm Distress Baby Scale (ADBB, Guedeney & Fermanian, 2001). Saliva samples were collected at 8-12 weeks old, both before and after a routine inoculation for cortisol reactivity measurement. Mother-infant interaction was evaluated at 12-16 weeks, using the Global Rating Scales (GRS, Murray, Fiori-Cowley, Hooper, & Cooper, 1996). Mothers’ reports on infant temperament at 3 and 12 months were collected using the Infant Behavior Questionnaire (IBQ, Rothbart, 1981). Significant differences in mothers’ perception of infant temperament were found at both 3 and 12 months in infants with distinct psychophysiological profiles. Stability was observed in most of the temperament's dimensions from 3 to 12 months old; still, there were changes in mothers’ perception of infant temperament in terms of level of distress, cuddliness, sadness and approach. Infant psychophysiological profile and mother-infant interaction both influence with the pattern of those changes. The results corroborate that infant's characteristics early in life as well as contextual factors influence with mothers’ perception of infant temperament and with changes across the 1st year of life.     

Effect of early intervention on social interaction between mothers and preterm infants at 12 months of age: a randomized controlled trial

In a randomized controlled trial at 12-months of age, the effect of the Mother Infant Transaction Program was tested on social interaction between mothers and moderately and late preterm infants with gestational age ≥ 30.0 and <36 weeks. Ninety-three play sessions were videotaped and coded, 46 mothers-infants in the intervention group and 47 mothers-infants in the control group. The intervention mothers scored higher on maternal sensitivity/responsiveness (p = .05). Being a first-time mother was a moderator that enhanced the effects of the intervention. First-time mothers were more sensitive/responsive to their infant's cues (p = .01), and the dyads evinced higher level of synchrony (p = .02) as compared with experienced mothers. More positive mood was observed among their infants (p = .04). The findings suggest that the intervention contributes to better mother-infant interactions in moderately and late preterm infants of first-time mothers.     

Associations between mother-infant bed-sharing practices and infant affect and behavior during the still-face paradigm

Parents in the United States increasingly report bed-sharing with their infants (i.e., sleeping on a shared sleep surface), but the relationship between bed-sharing and child socioemotional outcomes are not well understood. The current study examines the links between mother-infant bed-sharing at 3 months and infant affect and behavior during a dyadic challenge task at 6 months. Further, we examine nighttime mother-infant contact at 3 months as a possible mechanism that may mediate linkages between bed-sharing and infant outcomes. Using observational data from a sample of 63 mother-infant dyads, we found that infants who bed-shared for any proportion of the observation period at 3 months displayed significantly more self-regulatory behaviors during the still-face episode of the Still-Face Paradigm (SFP) at 6 months, compared to non-bed-sharing infants. Also, infants of mothers who bed-shared for the entire observation period displayed significantly less negativity during the reunion episode than non-bed-sharing infants. There was no evidence that the relations between mother-infant bed-sharing practices and infant affect and behavior during the SFP were mediated through nighttime mother-infant contact. Results suggest that infant regulation at 6 months postpartum may vary based on early nighttime experiences, with bed-sharing potentially promoting more positive and well-regulated behavior during dyadic interaction.     

Emotional interaction in a group of preterm infants at 3 and 6 months of corrected age

Twenty preterm infants (birthweight<1500 g) and 20 healthy fullterm infants were compared with respect to emotional interaction with their mothers in a face‐to‐face situation at 3 months of age and in a feeding situation at 6 months of age (ages corrected for preterm birth). The assessed outcome was analysed with respect to infant variables (group, gender, gestational age, birthweight and neonatal risk factors) and maternal variables (age, education and parity). The outcomes at 3 and 6 months of age were also compared with findings of Griffiths’ testing at 10 months of age. At 3 months of age, the findings reveal no significant difference between the two groups with respect to emotional interaction. Maternal variables are more important for this interaction than are infant variables. The mother's level of formal education has a significant impact in both groups. In the group of fullterm infants, significantly lower scores for interaction are obtained by first‐time mothers in comparison with multi‐parae mothers. At 6 months of age, the difference between fullterm and preterm infants is significant. The preterm infants and their mothers now relate to one another more poorly than is the case for the fullterm dyads. These findings suggest that the difficulties encountered by the preterm infant emerge with time. Emotional interaction at this age and the results of Griffiths’ testing 4 months later are significantly correlated. Copyright © 1999 John Wiley & Sons, Ltd.     

Joint attention in term and preterm infants at 12 months corrected age: the significance of gender and intervention based on a randomized controlled trial

This study tested the effects of optimized neonatal mother–infant transactions on joint attention performance at 12 months. Surviving infants <2000 g from a geographically defined area were randomly assigned to a preterm intervention (n = 71) or preterm control group (n = 69). Comparisons were made between preterm groups, secondary with a term group (n = 75). Joint attention was measured using the Early Social Communication Scales. Preterm intervention infants scored significantly higher than preterm control infants on elements Initiating Joint Attention (p < 0.05), Initiating Object Requests (p < 0.05), and Responding to Social Interaction (p < 0.0005). Intervention was not associated with performance on elements Responding to Joint Attention, or on Responding to Requests. ELBW infants scored significantly lower than VLBW and LBW infants on imperative functions. Girls outperformed boys on all communication elements. An intervention implemented during the neonatal period can be of advantage for certain aspects of joint attention performance in preterm infants.     

Maternal positive responses to a distressed infant simulator predict subsequent negative affect in infants

Existing evidence indicates that maternal responses to infant distress, specifically more sensitive and less inconsistent/rejecting responses, are associated with lower infant negative affect (NA). However, due to ethical and methodological constraints, most existing studies do not employ methods that guarantee each mother will be observed responding to infant distress. To address such limitations, in the current study, a distressed infant simulator (SIM), programmed to be inconsolable, was employed to ensure that mothers (N = 150; 4 months postpartum) were observed responding to infant distress. Subsequently, maternal report of infant NA and an early aspect of regulatory capacity, sootheability, were collected at eight-months postpartum, and observational assessments of infant fear and frustration, fine-grained aspects of NA, were collected at 12-months of age. After controlling for infant sex, the proportion of time mothers spent using soothing touch during the SIM task was related to less overall maternal reported NA and sadness at eight-months postpartum. Similarly, greater use of touch was associated with less fear reactivity, and greater maternal use of vocalizations was related to lower infant frustration, at 12-months postpartum. Specific maternal soothing behaviors were not related to infant soothability at 8 months postpartum. Total time spent interacting with the SIM was not related to infant temperament, suggesting that type of soothing, not quantity of interactions with distressed infants, is important for reducing infant NA. The implications of these findings and important future directions are discussed.     

Emotional and neuroendocrine regulation in very preterm and full-term infants at six months of age

Emotional and neuroendocrine regulation have been shown to be associated. However, results are inconsistent. This paper explores the functioning and relationships between these two systems in 54 healthy preterm and 25 full-term born infants at six months of age. Results showed significant differences between very preterm and full-term children in emotional intensity and regulation, as well as in neuroendocrine regulation. No evidence of an association between neuroendocrine and emotional regulations was found. Results suggest a possible delay in the maturation of the neuroendocrine system as well as in emotional regulation in very preterm infants.     

Experiencing positive affect and negative affect during stress: relationships to cardiac reactivity and to facial expressions

We examined the relationship between experienced positive/negative affect and cardiac reactivity and facial muscle movements during laboratory tasks with different demands. Heart rate, respiratory sinus arrhythmia, pre-ejection period, and facial electromyography were measured during startle, mental arithmetic, reaction time task, and speech task. The results revealed that individuals experiencing high levels of positive affect exhibited more pronounced parasympathetic, heart rate, and orbicularis oculi reactivity than others. Individuals who experienced high levels of negative affects during the tasks showed higher corrugator supercilii responses. Men and women showed slightly different response patterns. To conclude, cardiac reactivity may be associated with positive involvement and enthusiasm in some situations and all reactivity should not automatically be considered as potentially pathological.     

The effects of polydrug use with and without cocaine on mother-infant interaction at 3 and 6 months

The face-to-face interactions of 43 polydrug-with-cocaine-using mothers and their infants at 3 and 6 months were compared to 17 non-cocaine-but other-drug-using mothers and 21 mothers who used no drugs during their pregnancy. Coders blind to mothers' drug use status scored 3 min of face-to-face interactions for 16 measures of maternal and infant interactive behaviors. A principal component of 7 behaviors formed a measure of maternal attentiveness; a principal component of 5 behaviors formed a measure of mother-infant dyadic organization; and a principal component of 4 behaviors formed a measure of infant readiness to interact. A measure of maternal interruption was computed as the mean standard score of 3 additional interruptive behaviors. At 3 and 6 months, polydrug-with-cocaine-using mothers were less attentive to interactions, and polydrug-with-cocaine-using mothers and their infants engaged in fewer dyadic interactions than either non-cocaine or non-drug-using mothers. Compared to 3 months, polydrug-with-cocaine-using mothers at 6 months were less attentive to interactions and more frequently interrupted interactions by looking away, redirecting the infant, or withdrawing, whereas non-cocaine-using and non-drug- using mothers showed no change or an improvement in attentiveness to interactions and a decrease in interruptions. No differences emerged in the interactive behaviors of the infants of polydrug- with-cocaine-using, non-cocaine-using, or non-drug-using mothers. Cocaine use represents a significant risk for diminished parental attentiveness and responsiveness to infants and for diminished interactiveness in infants.     

Expression of negative affect during face‐to‐face interaction: a double video study of young infants' sensitivity to social contingency

The purpose was to assess infants' sensitivity to social contingency, taking affective state into account, during face‐to‐face interaction with the mother in a double video set‐up. Infants' behaviour during three sequences of live face‐to‐face interaction were compared to two sequences where the interaction between the infant and the mother was set out of phase, by presenting either the infant or the mother with a replay of their partners' behaviour during earlier live interaction. We found a significant negative correlation between the infant's degree of negative affect and the average time of looking at the mother during the live sequences. A median split was calculated to separate the infants into a high‐negative‐affect group and a low‐negative‐affect group on the basis of their emotional responses during the experiment. The low‐negative‐affect infants looked significantly more at their mothers than other foci during the live but not the replay sequences, while the high‐negative‐affect infants did not show this difference. The results suggest that 2–4‐month old infants are able to distinguish between experimental distortion of contingent aspects in live and replay sequences, but that this effect of the replay condition may not be shown by moderate to highly distressed infants. Our findings underline the importance of taking infants' emotional state into account in experiments intended to assess their capacity for intersubjective communication. Copyright © 2006 John Wiley & Sons, Ltd.     

Dyadic co-regulation,affective intensity and infant's development at 12 months: A comparison among extremely preterm and full-term dyads

Extremely low gestational age children (ELGA, born below 28 weeks of GA) represent the most at-risk preterm group in terms of survival, developmental sequelae and rates of impairment and cognitive delays. However, the impact of an extremely preterm birth on mother–infant co-regulation and affective intensity which may affect early infant's development has not been investigated. Based on a relational dynamic system approach, our study aimed to investigate the quality of co-regulation and affective intensity during spontaneous play interaction in 20 mother–infant ELGA dyads compared to 20 full-term (FT) dyads at 12 months (corrected age for ELGA infants). Relationships between the quality of dyadic co-regulation and the infant's level of cognitive, motor and language development were also investigated. The quality of dyadic co-regulation was assessed using the Revised Relational Coding System (R-RCS) by Fogel et al. (2003), the mothers’ and infants’ affective intensity was coded using a coding system by Lunkenheimer, Olson, Hollenstein, Sameroff, and Winter (2011). Infants’ development was assessed using the Bayley Scales (BSID-III, 2006). With respect to FT dyads, ELGA dyads were characterised by less frequent symmetric and more frequent unilateral co-regulation patterns and by less positive and more neutral affective intensity of both infants and mothers. Cognitive, motor and language scores were lower in ELGA infants than in FT infants. Symmetrical co-regulation was related to motor scores in ELGA infants, and to cognitive scores in FT infants. Our findings contribute to the literature by demonstrating the difficulties of ELGA mother–infant dyads at 12 months in sharing the symmetric co-regulation and positive affective intensity and how symmetric co-regulation is strictly related to motor development in ELGA infants. Based on these findings, intervention programmes to foster joint attention, active involvement and positive affective intensity in ELGA dyads and infants’ development in the first year of life should be designed.     

Precursors of social emotional functioning among full-term and preterm infants at 12 months: Early infant withdrawal behavior and symptoms of maternal depression

This study forms part of a longitudinal investigation of early infant social withdrawal, maternal symptoms of depression and later child social emotional functioning. The sample consisted of a group of full-term infants (N = 238) and their mothers, and a group of moderately premature infants (N = 64) and their mothers. At 3 months, the infants were observed with the Alarm Distress Baby Scale (ADBB) and the mothers completed the Edinburgh Postnatal Depression Scale (EPDS). At 12 months, the mothers filled out questionnaires about the infants’ social emotional functioning (Infant Toddler Social Emotional Assessment and the Ages and Stages Questionnaire-Social Emotional). At 3 months, as we have previously shown, the premature infants had exhibited more withdrawal behavior and their mothers reported elevated maternal depressive symptoms as compared with the full-born group. At 12 months the mothers of the premature infants reported more child internalizing behavior. These data suggest that infant withdrawal behavior as well as maternal depressive mood may serve as sensitive indices of early risk status. Further, the results suggest that early maternal depressive symptoms are a salient predictor of later child social emotional functioning. However, neither early infant withdrawal behavior, nor gestational age, did significantly predict social emotional outcome at 12 months. It should be noted that the differences in strength of the relations between ADBB and EPDS, respectively, to the outcome at 12 months was modest. An implication of the study is that clinicians should be aware of the complex interplay between early infant withdrawal and signs of maternal postpartum depression in planning ports of entry for early intervention.     

Maternal avoidance,anxiety cognitions and interactive behaviour predicts infant development at 12 months in the context of anxiety disorders in the postpartum period

BackgroundFew studies have examined the relation between anxiety disorders in the postpartum period and cognitive as well as language development in infancy.AimsThis longitudinal study investigated whether anxiety disorder in the postpartum period is linked to infant development at twelve months. A closer look was also taken at a possible link between maternal interaction and infant development.Study designSubjects were videotaped during a Face-to-Face-Still-Face interaction with their infant (M = 4.0 months). Specific maternal anxiety symptoms were measured by self-report questionnaires (Anxiety Cognition Questionnaire (ACQ), Body Sensations Questionnaire (BSQ), Mobility Inventory (MI)) to check for a connection with infant development. The Bayley Scales of Infant and Toddler Development-III (Bayley-III) were used to assess infant language and cognitive development at one year of age.Subjectsn = 34 mothers with anxiety disorder (SCID-I; DSM-IV) and n = 47 healthy mothers with their infant.Outcome measuresInfant performance on Bayley-III language and cognitive scales.ResultsInfants of mothers with anxiety disorder yielded significantly lower language scores than infants of controls. No significant group differences were found regarding infant cognitive development. Exploratory analyses revealed the vital role of “maternal avoidance accompanied” in infant language and cognitive development. Maternal neutral engagement, which lacks positive affect and vocalisations, turned out as the strongest negative predictor of cognitive development. Maternal anxiety cognitions and joint activity in mother-infant interaction were the strongest predictors of infant language performance.ConclusionsResults underline the importance to also consider the interaction behaviour of women with anxiety disorders to prevent adverse infant development.     

Regulatory competence and social communication in term and preterm infants at 12 months corrected age. Results from a randomized controlled trial

Temperamental regulatory competence and social communication in term and preterm infants at 12 months corrected age was studied in a randomized controlled intervention trial aimed at enhancing maternal sensitive responsiveness. Surviving infants <2000 g from a geographically defined area were randomized to an intervention (71) or a control group (69), and compared with term infants (74). The intervention was a modified version of the "Mother-Infant Transaction Program". Regulatory competence was measured with the Infant Behavior Questionnaire, and social communication with the Early Social Communication Scales. Preterm intervention infants with low regulatory competence had higher responding to joint attention than preterm control infants. A sensitizing intervention may moderate the association between temperament and social communication, and thus allow an alternative functional outlet for preterm infants low in regulatory competence. The finding may have implications for conceptualizations of the role of early sensitizing interventions in promoting important developmental outcomes for premature infants.     

Infants' interactions with professional caregivers at 3 and 6 months of age: a longitudinal study

This study longitudinally investigated the quality and stability of 64 infants’ interactions with their professional caregivers in child care centers at 3 and 6 months of age, i.e., across the first 3 months after they entered child care. It was also examined whether the infants’ negative emotionality (as rated by the mother) predicted the quality of the caregiver–infant interaction. The interactive behavior of the professional caregivers (sensitivity, cooperation) and the infants (responsiveness, involvement) was rated from videotapes recorded in three different caregiving situations, lasting about 25 min in total. In contrast to our expectation, the quality of the caregiver–infant interaction did not significantly increase across the first 3 months in child care. As expected, significant rank order stability was found for the quality of the caregivers’ behavior over time. Also in accordance with our expectations, infants with higher negative emotionality scores experienced less sensitivity and cooperation in interactions with their primary professional caregivers at both ages.